Pathology tests and health insurance

Will your private health insurance policy cover the cost of blood tests? Read on to find out.


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If your doctor has ordered you to undergo a blood test, you might be wondering how much this procedure is going to cost. You might also be confused as to whether some or all of the cost will be covered by Medicare or your private health insurance fund, so let’s take a look at how blood tests work and whether you will need to pay for them out of your own pocket.

Does private health insurance cover blood tests?

Private health insurance can sometimes cover the cost of blood tests, but whether or not your policy provides cover depends on whether you receive treatment as an inpatient or outpatient.

If you undergo a pathology test while you are admitted to hospital as an inpatient, hospital cover from your private health fund can cover this expense.

If you undergo a pathology test as an outpatient – ie your GP recommends that you undergo a blood test – you won’t be covered. Instead, outpatient services are only covered by Medicare (unless you’re an overseas visitor, in which case your private health insurance may provide some cover).

However, even if cover for the cost of a blood test is provided by Medicare and/or private health insurance, there may be some out-of-pocket costs. This occurs if the pathology costs are greater than the Medicare rebate and the amount covered by your private health fund.

How much do blood tests cost?

The cost of blood tests varies depending on the type of test. However, under Australian legislation, pathology testing providers cannot issue invoices for pathology services until all testing has been completed.

With this in mind, you won’t know for sure exactly how much a blood test will cost before your blood is collected, but the pathology service can provide you with an estimate of your out-of-pocket expenses. You can also ask your doctor for information about how the pathology tests will be billed.

The good news is that Medicare can help cover the cost of blood tests in many situations.

Are pathology tests covered by Medicare?

The Australian Government provides funding for a wide range of pathology tests through the Medicare Benefits Schedule (MBS). However, you will only be eligible for a rebate on a blood test listed on the MBS if the following conditions are met:

  • The pathology test must be requested by your treating practitioner (the practitioner must be registered with Medicare)
  • There must be a medical reason for the blood test
  • Your blood sample must be sent to a pathology laboratory that is approved by Medicare
  • The pathology test has been supervised and has undergone quality assurance in line with Medicare accreditation rules

As an example, if a blood test is requested for insurance purposes rather than for a medical reason, it will not be eligible for a rebate.

It’s also worth pointing out that there are sometimes limits on the number of times you can receive a rebate for the same blood test in a 12-month period. More details about any limits that apply can be found in the MBS.

What is a blood test?

A blood test can be used to assess your overall health and help your doctor diagnose or observe and check the progress of a wide range of conditions. When you undergo a blood test, a small amount of blood is taken from a vein in your arm and then sent off to a pathology service to be tested and analysed.

Also known as pathology tests, blood tests generally produce accurate results but can sometimes produce “false positives” or “false negatives”. Blood tests can be used for an incredibly diverse range of purposes, from checking that your major organs are working correctly to assessing how well your blood is clotting, checking the effectiveness of medications you are taking and testing for diseases such as cancer and diabetes.

What happens during a blood test?

In some cases you may be required to take certain steps to prepare for a blood test, such as fasting for a specific period of time.

Blood tests can be conducted in hospital or at a pathology collection centre. Once you’ve provided your doctor’s referral and confirmed your personal details, the collector will usually place a tourniquet around your arm and insert a needle into your vein.

A small amount of blood will be taken and then collected in one or multiple tubes before being sent to a pathology service for analysis. You’ll be asked to apply pressure to the needle site for a short period and you should minimise the use of that arm for the next 24 hours.

Some patients can suffer from dizziness or even faint after blood is taken. If you think you’re at risk of this, be sure to keep your fluids up and stay seated for a while after your blood has been collected.

Once your blood sample has been tested and analysed, the results will be sent to your doctor. The time it takes for your results to be ready will vary depending on the type of test you have done.

What is a Pap smear and how much does it cost?

If your doctor has recommended that you get a Pap test or if you’ve simply been putting it off for a while and decided that it’s time to have one, you might be wondering if you’ll have any out-of-pocket expenses.

The good news is that Medicare provides cover for most of the cost of a Pap test. If your medical practice bulk bills, you probably won’t have to pay any out-of-pocket costs.

However, some medical professionals will charge a fee for performing the Pap test or for the laboratory testing process. As a result, you may have to pay the portion of the total cost that exceeds the Medicare rebate.

The MBS lists the fee for a Pap test as $19.45 so a 75% benefit equals $14.60 and an 85% benefit is $16.55.

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